Healthcare Provider Details

I. General information

NPI: 1952284465
Provider Name (Legal Business Name): LACAYO GENET LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2025
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 CHERRY CREEK RD
CLOVERDALE CA
95425-3845
US

IV. Provider business mailing address

114 ST MICHAEL CT
CLOVERDALE CA
95425-3878
US

V. Phone/Fax

Practice location:
  • Phone: 707-669-5020
  • Fax: 866-583-0762
Mailing address:
  • Phone: 707-367-2725
  • Fax: 866-583-0762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State

VIII. Authorized Official

Name: MELISSA GENET
Title or Position: PARTNER
Credential:
Phone: 707-367-2725